Abstract
Background: Common bridging vein (BV) -type dural arteriovenous fistulas (DAVFs) are typically located the tentorium cerebelli. Similar DAVFs are found near the transverse-sigmoid sinus (TSS). They are often reported together with true TSS DAVFs, which involve direct arterialization of the TSS serving as the point of fistulization. Distinguishing between BV-type TSS DAVFs and true TSS DAVFs is crucial because the treatment strategies and outcomes for each can differ significantly. Here, we present a consecutive case series of BV-type TSS DAVFs from our institution, detailing their clinical presentations, treatment strategies, and both clinical and radiographic outcomes.
Methods: This retrospective study analyzed 50 patients with BV-type TSS DAVFs who were hospitalized at a single medical center between 2002 and 2022.
Results: We identified 50 patients with BV-type TSS DAVFs. The cohort consisted of 44 men and 6 women, with a mean ± SD age of 55.4 ± 9.6 years at symptom presentation. 48 patients underwent trans-arterial embolization (TAE), one underwent surgery, and one received conservative treatment. All fistulas were classified as Borden type Ⅲ. Immediate complete occlusion was achieved in 98% cases. 28 (100%, 28/28) patients were cured, with no recurrence detected on final follow-up imaging.
Conclusions: BV-type TSS DAVFs are associated with a high risk of hemorrhage and non-hemorrhagic neurological deficits. TAE achieved a high cure rate for these lesions with no major complications. Due to the unique location of these fistulas at the junctional zone of the bridging vein and the TSS, hypotheses regarding their pathogenesis have been proposed, though they remain unconfirmed.